Pre-op vs Post-op Diagnosis

Question:

Is there a difference between a pre-operative diagnosis and a post-operative diagnosis?

Answer:

Pre-operative diagnosis is based on the “Reason for the surgery” or the condition affecting the patient, leading to the necessity of the surgery. Underlying co-morbidities that can affect the surgical outcome or represent a risk to the patient can also be included but the documentation must support their relationship to the patient risk.

Post-operative diagnoses are based on the findings determined during the surgical procedure.  Post-op diagnosis may be the same as the pre-op diagnosis or may be more definitive.

*This response is based on the best information available as of 12/19/24.

Pre-op vs Post-op Diagnosis

Question:

Is there a difference between a pre-operative diagnosis and a post-operative diagnosis?

Answer:

Pre-operative diagnosis is based on the “Reason for the surgery” or the condition affecting the patient leading to the necessity of the surgery. Underlying co-morbidities that can affect the surgical outcome or represent a risk to the patient can also be included but the documentation must support their relationship to the patient risk.

Post-operative diagnoses are based on the findings determined during the surgical procedure.  Post-op diagnosis may be the same as the pre-op diagnosis or may be more definitive.

*This response is based on the best information available as of 12/19/24.

Can We Append Modifier 59?

Question:

Is it appropriate to report 64718, 64721, and 64719 together on the same hand-right side? We see there is an NCCI edit; should we append modifier 59? 

Answer:
Thank you for contacting KZA with your great question!

You are correct; there is an NCCI bundling edit in place. CPT code 64719 is bundled into 64721.

There is no overlap between an open carpal tunnel release (64721) and open ulnar nerve surgery (64718) at the elbow. Append modifier 51 to the lesser valued code.

There is an overlap between 64721 and 64719 (ulnar nerve decompression at Guyon’s canal). To report CPT codes 64721 and 64719 (ulnar nerve decompression at Guyon’s canal) there must be documentation present of pre-operative diagnostic studies indicating the presence of ulnar nerve pathology. This documentation must be listed in the pre-op diagnosis and the results in the Indication for Surgery paragraph. CPT code 64719 is not reportable with 64721 without the documentation of diagnostic test studies. If present, CPT codes 64721 and 64719 are both reportable. An NCCI edit exists, so modifier 59 is appended in the presence of documentation.

*This response is based on the best information available as of 12/19/24.

Pre-op vs Post-op Diagnosis

Question:

Is there a difference between a pre-operative diagnosis and a post-operative diagnosis?

Answer:

Pre-operative diagnosis is based on the “Reason for the surgery” or the condition affecting the patient leading to the necessity of the surgery. Underlying co-morbidities that can affect the surgical outcome or represent a risk to the patient can also be included but the documentation must support their relationship to the patient risk.

Post-operative diagnoses are based on the findings determined during the surgical procedure.  Post-op diagnosis may be the same as the pre-op diagnosis or may be more definitive.

*This response is based on the best information available as of 12/19/24.

Which Modifier Should I Use?

Question:

I need some help with using Modifiers. I work for a Mohs surgeon, and he frequently performs Mohs, and the patient comes back differently for a flap or graft. They usually come back within a week. What modifier should I add to the repair when the patient returns?

Answer:

Mohs Micrographic surgery has a global period of “0” days. That means if the patient comes back for the repair on a different date, no modifier is required. 

*This response is based on the best information available as of 12/19/24.

Periprosthetic fractures ICD-10

Question:

I'm new to coding ortho and I am very confused on how to code periprosthetic fractures. I was under the impression that only one ICD-10 was required for this type of fracture (M97.x). What am I missing?

Answer:

There is a category of codes in ICD-10, specific to Periprosthetic fractures around internal prosthetic joints, and the category is M97. When referring to the tabular section of ICD-10, under M97 category there is an instructional note which states the following: code first, if known, the specific type and cause of the fracture. That being said, if the documentation reflects the site and type of fracture while also identifying this as a periprosthetic fracture around an internal prosthetic joint, you will assign the primary ICD-10 code for the known fracture, followed by ICD-10 from M97 series to identify the periprosthetic fracture for the specific joint. 

Example: Displaced comminuted periprosthetic fracture of the proximal shaft of the right femur, patient status post right total hip replacement. 

ICD-10 codes: 

1) S72.351A 

2) M97.01XA 

Let's take this one step further, according to ICD-10, if you have a periprosthetic fracture around a prosthetic joint in which there is no specific code, then you would report M97.8XX-, and then use an additional ICD-10 code to identify the joint Z96.6-. The ICD 10 instructions for M97 instruct to code first, if known, the specific type and cause (e.g. pathologic or traumatic). If you read on to M97.8, there are additional instructions to also report the appropriate joint (Z96.6-). As you can see, the instructions and hierarchy are a bit different when there is a specific joint arthroplasty code versus not. 

Example: Displaced comminuted periprosthetic fracture of the right distal radial shaft, patient status post right wrist arthroplasty. 

ICD-10 codes: 

1) S52.351A 

2) M97.8XXA 

3) Z96.631 

*This response is based on the best information available as of 12/19/24.